ESICM Talk

Clinicians use noninvasive respiratory support interventions in the post-extubation period to mitigate the risk of extubation failure. These interventions [noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC)] have been shown to be efficacious in preventing initial intubation in patients with hypoxemic respiratory failure, but their efficacy in preventing post-extubation respiratory failure and reintubation is less clear.

A systematic review and network meta-analysis of randomised controlled trials (RCTs) to evaluate the relative efficacy of conventional oxygen therapy, NIPPV, HFNC, and the strategy of alternating NIPPV and HFNC during the post-extubation period in reducing extubation failure and short-term mortality among critically ill adults, was conducted. We have interviewed Dr Fernando and Dr Rochwerg to explain these study findings.

Speakers

Shannon FERNANDO. Division of Critical Care, Department of Medicine, University of Ottawa (CA).

Bram ROCHWERG. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton (CA) and Department of Medicine, Division of Critical Care, McMaster University, Hamilton (CA).

Ahmed ZAHER. Oxford University Hospitals (UK). ESICM Next Committee member.

Kidney transplantation is the most common solid organ transplant performed worldwide. New advances in transplant medicine have expanded the indications for kidney transplantation, and nowadays, many kidney recipients are elderly patients who possibly have more comorbidities.

Up to 6% of kidney transplant recipients experience a life-threatening complication requiring intensive care unit admission, primarily in the late post-transplant period (≥6 months). The most common medical complications requiring ICU admission in the immediate postoperative period are cardiac events and infections.

Approximately 40% of recipients throughout their ICU stay require renal replacement therapy. In-hospital mortality can be as high as 30% and is related to the severity of the acute illness and the reason for admission to the ICU.

To further discuss the challenges involved in managing these patients in the ICU, we invited Dr Clare MacEwen, a specialist in the field.

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Speakers

Clare MACEWEN. Intensive care, Renal and a critical care echocardiography consultant, Oxford university hospitals (UK).

Ahmed ZAHER. Oxford University Hospitals (UK). ESICM Next Committee member.

Neuromonitoring is considered a crucial and fundamental process to monitor patients in critical care settings.

In this podcast, ESICM NEXT member Denise Battagliani interviews Chiara Robba on the ultimate findings regarding neuromonitoring, including:

• basics of neuromonitoring research;
• indications for neuromonitoring of patients who do (not) suffer any direct brain injury;
• the rationale in neuromonitoring patients with sepsis, COVID-19 and liver failure and the most appropriate tools to use for each of this cohort of patients;
• the use of neuromonitoring tools during the perioperative period for neurosurgical patients and patients who undergo cardiac and vascular surgeries.

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Speakers

Chiara ROBBA. Consultant in Neuro and General Intensive Care, Policlinico San Martino Genoa, (IT). Chair-Elect of the Neuro Intensive Care section of the ESICM.

Denise BATTAGLINI. Consultant in intensive care at San Martino Policlinico Hospital, Genoa, Italy (IT). ESICM NEXT Committee Member.

Systemic corticosteroids decrease mortality in critically ill patients with COVID-19, and the World Health Organization, therefore, recommends dexamethasone 6 mg daily for up to 10 days for patients with severe or critical COVID-19. In addition, higher doses of systemic corticosteroids have been used in patients with COVID-19 and non-COVID-19 acute respiratory distress syndrome [3, 5, 6], and higher doses have been hypothesised to benefit patients with severe or critical COVID-19. However, the balance between benefit and harm remains uncertain.

The COVID STEROID 2 trial compared a higher (12 mg) versus recommended dose (6 mg) of dexamethasone daily, for up to 10 days, in patients with COVID-19 and severe hypoxaemia.

Dr Granholm was interviewed by ICM Associate Editor Dr Shankar-Hari about the methodology and the findings of the study.

Original paper: Dexamethasone 12 mg versus 6 mg for patients with COVID-19 and severe hypoxaemia: a pre-planned, secondary Bayesian analysis of the COVID STEROID 2 trial

Speakers

Anders GRANHOLM. Department of Intensive Care, Rigshospitalet—Copenhagen University Hospital (DK) and Collaboration for Research in Intensive Care (CRIC), Copenhagen (DK).

Manu SHANKAR-HARI. Usher Institute, University of Edinburgh (UK) and Centre for Inflammation Research, University of Edinburgh (UK)and School of Immunology and Microbial Sciences, King's College London, (UK). ICM Associate Editor.

Attempts at improving cardiac arrest outcomes have increasingly included extracorporeal techniques to re-establish circulation. In particular, the application of veno-arterial extracorporeal membrane oxygenation (ECMO) during cardiac arrest is called extracorporeal cardiopulmonary resuscitation (ECPR).

However, there is much debate about the impact of ECPR use on survival and neurological and functional recovery in adults suffering cardiac arrest.

These issues have been evaluated in a systematic review conducted by Dr Abrams et al.

Listen to the following podcast to hear more about which patients are most likely to benefit from EPCR, required resources and relevant ethic issues on using EPCR.

Original article: Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications

Speakers:

Darryl ABRAMS. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York (USA).

Laura BORGSTEDT. Department of Anesthesiology, Klinikum rechts der Isar, Technical University of Munich, Munich (DE).

Metabolic resuscitation is an adjunctive therapy for sepsis and septic shock, which consists of a combination of vitamin C, glucocorticoids, and vitamin B1 or their components. Recently, there has been considerable interest in this treatment. However, due to the wide range of combinations of its components, there is no evidence for the effectiveness of this therapy.

To fill this gap, a network meta-analysis (NMA) and component NMA was conducted. This analysis summarised the available evidence concerning these therapies and determined any incremental effect of each component when added to sepsis treatment.

In the following podcast, Dr Fuji explains the methodology employed and details the study results.

Original paper: Effect of adjunctive vitamin C, glucocorticoids, and vitamin B1 on longer-term mortality in adults with sepsis or septic shock: a systematic review and a component network meta-analysis.

Speakers:

Tomoko FUJII. Intensive Care Unit, Jikei University Hospital, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 (JP). Australian and New Zealand Intensive Care Research Centre.

Inès LAKBAR. Service Anesthésie - Réanimation Pr LEONE - AP-HM - Hôpital Nord - Marseille (FR).

Integrating palliative care in critical care is advocated as a way to mitigate physical and psychological burdens for patients and their families and improve end-of-life care.

Despite the emerging literature published that supports this positive association, the quality of evidence remains limited, in large part due to limitations in the definition of interventions, poor precision of effect estimates and the large variation in study designs.

In a systematic review, Dr Victoria Metaxa et al. highlight the heterogeneous interventions and diverse outcome metrics used and propose a new classification of interventions to facilitate future comparisons.

Follow our conversation with Dr Victoria Metaxa and Dr Christiane Hartog in the following podcast.

Speakers:

Ahmed ZAHER. Oxford University Hospitals (UK). ESICM Next Committee member.

Victoria METAXA. King’s College Hospital, London (UK).

Christiane HARTOG. Charité Universitätsmedizin, Berlin (DE).

Given the rapidity with which critically ill patients with bleeding can deteriorate, having a standardised approach to transfusion in these patients can be of great assistance to clinicians working in time-pressured circumstances.

An expertise task force created within ESICM has developed an international guideline that provides guidance for clinicians caring for critically ill patients with massive and non-massive bleeding.

26 clinical practice recommendations (2 strong recommendations, 13 conditional recommendations, 11 no recommendations), and 11 PICO (population, intervention, comparison, and observation) with insufficient evidence to make recommendations were generated and published.

To understand and clarify further this research, Dr Helms, ICM Associate Editor, has interviewed one of the leading experts of this study Dr A. Vlaar. Check out the following podcast to learn more.

Speakers:

Julie HELMS. Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (FR). Associate Editor of Intensive Care Medicine

Alexander P.J. VLAAR. Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam (NL).

Ultrasonography is an evolving skill in critically ill patients. We provide a large number of statements regarding the required ultrasonographic basic skills for the management of critically ill patients.

Original article:

Speakers: Basic ultrasound head-to-toe skills for intensivists in the general and neuro intensive care unit population: consensus and expert recommendations of the European Society of Intensive Care Medicine

Chiara ROBBA. Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l’Oncologia e le Neuroscienze, Genoa (IT) and Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa (IT). Chair, ESICM Neuro Intensive Care Section.

Adrian WONG. Department of Critical Care, King’s College Hospital, London (UK). Chair, ESICM Social Media & Digital Content Committee.

Antoine VIEILLARD-BARON. Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Billancourt, Boulogne (FR) and INSERM UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif (FR). ESICM Secretary.

Laura GALARZA. Hospital General Universitario, Castellón (ES); Chair-Elect, ESICM NEXT Committee

Critical illness occurs frequently after a new diagnosis of hematologic malignancy and has high associated mortality.

Baseline characteristics at diagnosis can help identify those patients at the highest risk of critical illness.

Original article: Critical illness in patients with hematologic malignancy: a population-based cohort study

Speakers:

Bruno L. FERREYRO. Interdepartmental Division of Critical Care Medicine, University of Toronto (CA).

Laveena MUNSHI. Interdepartmental Division of Critical Care Medicine, University of Toronto (CA).

Gaetano SCARAMUZZO. Department of Translational medicine, University of Ferrara (IT).